Journal & Issues

Volume 39 (2023): Issue 1 (January 2023)

Volume 38 (2022): Issue 2 (July 2022)

Volume 38 (2022): Issue 1 (January 2022)

Volume 37 (2021): Issue 2 (January 2021)

Volume 37 (2021): Issue 1 (January 2021)

Volume 36 (2020): Issue 2 (January 2020)

Volume 36 (2020): Issue 1 (January 2020)

Volume 35 (2019): Issue 2 (January 2019)

Volume 35 (2019): Issue 1 (January 2019)

Volume 34 (2018): Issue 2 (January 2018)

Volume 34 (2018): Issue 1 (January 2018)

Volume 33 (2017): Issue 2 (January 2017)

Volume 33 (2017): Issue 1 (January 2017)

Volume 32 (2016): Issue 2 (January 2016)

Volume 32 (2016): Issue 1 (January 2016)

Volume 31 (2015): Issue 2 (January 2015)

Volume 31 (2015): Issue 1 (January 2015)

Journal Details
Format
Journal
eISSN
2207-7480
First Published
01 May 1967
Publication timeframe
1 time per year
Languages
English

Search

Volume 37 (2021): Issue 2 (January 2021)

Journal Details
Format
Journal
eISSN
2207-7480
First Published
01 May 1967
Publication timeframe
1 time per year
Languages
English

Search

25 Articles
Open Access

Efficacy of fluoride varnish in treating orthodontically-induced white spot lesions: a systematic review and meta-analysis

Published Online: 21 Oct 2021
Page range: 147 - 156

Abstract

Abstract Objectives

To systematically review the effectiveness of 5% sodium fluoride varnish (FV) in the treatment of orthodontically-induced white spot lesions (WSLs).

Methods

A literature search of three independent databases (Medline, Cochrane Library and Web of Science) was performed from inception to November 2020. This systematic review included randomised/quasi-randomised clinical trials (RCTs) that used FV for patients who had at least one WSL as a result of fixed orthodontic treatment. Exclusion criteria were split-mouth study designs or studies that failed to report WSLs as the outcome variable or studies with less than 3 months follow-up. An Inverse-Variance fixed-effect method was performed for continuous variables. Changes in the mean difference (MD) for the DIAGNOdent (DD) scores following FV application were calculated at the 95% confidence interval (CI).

Results

Three of the four included studies showed significant improvement in the remineralisation of WSL after treatment with FV in comparison to control subjects. Three studies were conducted on patients after fixed orthodontic treatment and one study was conducted during treatment. The studies included a total of 284 participants with the majority in the age range of 10 to 25 years. The distribution of the participants was approximately equal in the FV and control group. When compared with the control group, there was a statistically significant reduction in the mean DD readings for the FV group at the 3-month (MD = -3.43; 95% CI: -4.72 to -2.15; p < 0.001) and at the 6-month (MD = -4.47; 95% CI: -4.72 to -2.15; p < 0.001) follow-up visit.

Conclusions

Although few studies have shown the effectiveness of FV application in the treatment of orthodontically-induced WSLs, the limited number of robust clinical trials, makes it difficult to draw a definitive conclusion.

Open Access

Pulp chamber temperature changes during orthodontic bonding – an in vitro study

Published Online: 21 Oct 2021
Page range: 157 - 164

Abstract

Abstract Aim

Using a thermal camera, the aim of the study was to determine pulp chamber temperature changes during orthodontic bonding produced as a result of variations in curing light sources, different curing distances and bracket types.

Methods

One hundred sixty maxillary premolar teeth were sectioned into two halves and embedded into acrylic moulds. Four curing light sources were used which further divided the overall sample into Halogen, light emitting diode (LED), powered LED, and high-power LED groups. Additional subgroups were created according to the applied curing distances (5 mm, 10 mm) and different bracket types (metallic or ceramic). A standardised bonding procedure was performed and pulp chamber temperature changes were evaluated using a thermal camera. Statistical analysis was performed using a three-way ANOVA.

Results

The Halogen light curing group revealed a significantly higher temperature rise in the pulp chamber compared to the other groups. A shorter curing distance produced increases in pulpal temperature. There was no significant effect as a result of the bracket type.

Conclusions

None of the curing light sources exceeded the critical value for pulp chamber temperature rise. The primary desirable outcome was the lowest temperature increase noted with the high-power LED unit. The secondary outcome related to the different brackets revealed no difference relative to pulp chamber temperature change. From a clinical perspective, high-power LED units could be safely used.

Open Access

The role of micro-implant-assisted rapid palatal expansion (MARPE) in clinical orthodontics — a literature review

Published Online: 21 Oct 2021
Page range: 206 - 216

Abstract

Abstract

A maxillary transverse deficiency is a common craniofacial problem. Rapid palatal expansion (RPE) has been traditionally considered for the treatment of children and young adolescents, but this is not applicable in late adolescents or adults due to the ossification of facial sutures. A surgically assisted rapid palatal expansion (SARPE) was initially advocated for this group of patients, but the surgical procedure is associated with morbidity. As temporary anchorage devices (TADs) have been recently and popularly applied in clinical orthodontics, micro-implant-assisted rapid palatal expansion (MARPE) has been employed to facilitate maxillary expansion in skeletally mature patients. There have been various proposed MARPE designs and the outcomes appear promising. The aim of the present article is to discuss the role of MARPE in clinical orthodontics by reviewing its background, design, indications, treatment effects, stability, and limitations in the current literature. The treatment effects of two types of MARPE, bone-borne and tooth-bone-borne (hybrid), will be individually assessed.

Open Access

Quantitative assessment of interproximal tooth reduction performed as part of Invisalign® treatment in 10 orthodontic practices

Published Online: 21 Oct 2021
Page range: 176 - 186

Abstract

Abstract Background

Interproximal reduction (IPR) is a treatment option for orthodontic space gain. The attainment of prescribed objectives in aligner treatment may require IPR that is accurately performed both qualitatively and quantitatively.

Objective

This study assesses the in vivo accuracy of IPR carried out in 10 orthodontic practices as a method of orthodontic space creation.

Methods

A comparison of proposed and achieved amounts of IPR completed (accuracy), the accuracy of IPR within and between upper and lower dental arches, and the accuracy of IPR within and between posterior and anterior arch segments were performed using 3-dimensional digital study models gained via Align’s® ClinCheck.

Results

The findings indicated that IPR was routinely underperformed by all practices studied. On average, the amount of IPR achieved represented only 44.0% of the total prescribed per tooth in the sample assessed, with a mean discrepancy of 0.16 mm per tooth. There were statistically significant differences only between the overall anterior and posterior groups (p < 0.01) and between maxillary anterior and maxillary posterior groups (p < 0.01); however, these were not clinically significant. Significant differences in IPR performance were noted between different orthodontic practices.

Conclusions

This study demonstrates that the clinical performance of IPR in 10 orthodontic practices consistently fails to achieve the prescribed amount often by large variations. The effect of this under-performance on clinical outcomes remains to be quantified.

Open Access

Perception of dental midline deviation and smile attractiveness by eye-tracking and aesthetic ratings

Published Online: 21 Oct 2021
Page range: 187 - 196

Abstract

Abstract Aim

To evaluate the perception of smile aesthetics and midline deviation considered by orthodontists (ORT), dentists (DT), patient’s-relatives (PR), and laypersons (LP) using an eye-tracking device and survey.

Methods

The study invited the participation of 42 orthodontists, 51 dentists, 50 patient-relatives, and 52 laypersons. A posed smile photograph of a female was chosen as a base image. The dental midline (DML) was digitally moved 1 mm (DML1R, DML1L), 2 mm (DML2R, DML2L), 3 mm (DML3R, DML3L), and 4 mm (DML4R, DML4L) on the base image’s right (DMLR) and left (DMLL) segments. Eight modified images were subsequently obtained. The base, modified, and repeated images were randomly arranged and uploaded into the Tobii Pro Lab software program for assessment by the participants. An eye-tracking dataset included first fixation duration (FFD), total fixation duration (TFD), and visit counts (VC). The participants also evaluated the photographs on the survey forms via a Visual Analogue Scale (VAS) and a Likert scale. The intra-group relations and inter-group correlations were evaluated statistically.

Results

The TFD for the DML2R photograph was found to be statistically significant between the assessment groups (p = 0.026). While the longest fixation time (0.93 sec) belonged to the orthodontists, it was observed that the patient relatives had the shortest fixation time (0.51 sec). The VAS score for the DML2R image was found to be highest in laypersons (p < 0.001). In general, the survey scores of the patient relatives and laypersons were higher.

Conclusion

The fixation time between the participant groups increased when there was a 2 mm deviation. A 2 mm shift in the DML was noticed by all participant groups and was considered unaesthetic.

Open Access

Multidisciplinary management of an adult skeletal Class III patient with generalized aggressive periodontitis and canine-premolar transposition

Published Online: 21 Oct 2021
Page range: 165 - 175

Abstract

Abstract

This case report presents orthodontic camouflage treatment and the correction of transposed canine-first premolar teeth in a patient who presented with a skeletal Class III and familial periodontal problem. A 28-year-old female patient who was diagnosed with generalised aggressive periodontitis was treated by scaling and root planing plus the adjunctive use of systemic antibiotics and surgical therapy prior to referral to the orthodontic department. After the progression of the disease was controlled, orthodontic treatment was commenced to correct the dental transposition by using a modified Nance-TPA appliance and sectional arch mechanics. A non-extraction orthodontic camouflage treatment was planned to eliminate the anterior crossbite and to establish a proper occlusion by closing the multiple diastemata. Treatment outcomes remained stable in the 2-year follow-up period. Severe orthodontic-periodontal problems can be successfully treated by oral hygiene motivation, an interdisciplinary approach, and the selection of appropriate biomechanics.

Open Access

A national survey of orthodontists in Malaysia and their use of functional appliances for Class II malocclusions

Published Online: 12 Oct 2021
Page range: 217 - 226

Abstract

Abstract Objectives

The aim of this study was to evaluate the use of functional appliances by the currently practising orthodontists in Malaysia. The objectives were to identify the different types of functional appliances used by Malaysian orthodontists and to investigate the variation in treatment protocols when attempting growth modification.

Methods

An online questionnaire consisting of 24 open-ended and multiple-choice questions was emailed to members of the Malaysian Association of Orthodontists (MAO) (n = 183). The survey was based on a previous study conducted by members of the British Orthodontic Society and was modified to suit the Malaysian population. The data were analysed using SPSS to generate frequency tables and descriptive statistics.

Results

Seventy-two responses were received from current Malaysian orthodontists. Of the respondents, 71% practised in a government setting and 29% were in private practice. The Clark Twin Block was the most frequently used functional appliance by 90% of Malaysian orthodontists. Many of the respondents (57%) prescribed full-time wear of removable functional appliances for 6–9 months (except during mealtimes) (51%). Following active removable functional appliance therapy, 91% prescribed a period of retention which involved a reduction in the duration of wear. The retention phase extended for 2 to 3 months (41%) or for 4 to 6 months (39%) for the majority of the respondents.

Conclusions

The Clark Twin Block is the most frequently-used functional appliance for the management of a Class II malocclusion by orthodontists currently practising in Malaysia.

Open Access

Class III malocclusion: a challenging treatment using miniscrews for extra anchorage

Published Online: 12 Oct 2021
Page range: 227 - 236

Abstract

Abstract Aims

This article presents the nonsurgical orthodontic treatment of a skeletal Class III malocclusion of an adult patient.

Methods

Because the patient refused an orthognathic surgical procedure, the mandibular first premolars were extracted and orthodontic camouflage using miniscrew anchorage was used to correct dental asymmetries and the occlusal relationship.

Results

The treatment strategy was successful and provided an acceptable aesthetic functional occlusion.

Conclusion

When appropriately indicated, the orthodontic camouflage of a class III malocclusion can avoid orthognathic surgery and, through the use of mini-implants as skeletal anchorage, enhance the results.

Open Access

The risk for paediatric obstructive sleep apnoea in rural Queensland

Published Online: 12 Oct 2021
Page range: 197 - 205

Abstract

Abstract Background

The importance of assessing patients for paediatric obstructive sleep apnoea (OSA) cannot be more highly stressed and orthodontists may play an essential role in risk screening. The Paediatric Sleep Questionnaire (PSQ) is a validated tool to identify whether a child is at risk for paediatric OSA.

Objectives

The likelihood of paediatric OSA in school-aged children residing in Far North Queensland (FNQ) will be assessed using the PSQ.

Methods

Parents of children aged between 4 and 18 years were invited to participate through schools and social media messaging to complete an online PSQ questionnaire to assess their OSA risk and demographics.

Results

The final sample consisted of 404 school-aged children of whom 62.5% were found to be at a high-risk for paediatric OSA. The high risk was significantly associated with males and those of overweight/obese BMI status (p < 0.001). Race and age were not significant associations (p > 0.05).

Conclusions

Within the contributing sample of school-aged children in FNQ, a significant number were found to be at high-risk of paediatric OSA. Males and overweight/obese children were measured risk factors.

Open Access

Cephalometric effects of the elastodontic appliance in managing skeletal Class II division 1 cases

Published Online: 01 Oct 2021
Page range: 251 - 258

Abstract

Abstract Aim

The aim of the study was to evaluate the cephalometric effects of the elastodontic appliance (EA) in the management of patients presenting with a skeletal Class II/1 malocclusion.

Methods

Twenty Class II patients treated using the EA (Group EA) were compared with 20 Class II untreated children (Group C). Cephalograms were compared at the start (T0) and after 24 months (T1) after which time, skeletal, dental, and aesthetic variables were evaluated. A statistical evaluation was conducted by applying an unpaired t-test for normally distributed variables.

Results

From T0 to T1, the EA group showed a significant increase in lower facial height (LFH), in mandibular length (Co-Gn), in the upper incisor and cranial plane angle (1 + SN) and in the distance between a true vertical line (TVL)-soft tissue B (B’) and TVL-soft tissue Pogonion (Pog’) points. From T0 to T1, group C showed a significant decrease in SN-occlusal plane (PO) (p < 0.01), of SN-mandibular plane (Go-Me) (p < 0.01) and of total gonial (N-Go-Me) angles (p < 0.05); a significant reduction of the distance between TVL-upper incisor (1+), TVL-lower lip (Li), and TVL-Pog’ was shown. No statistical differences were observed between the groups in dental and aesthetic outcomes, except for a skeletal increase in LFH (p < 0.05) and in Co-Gn length (p < 0.05), which was statistically significant in the EA group.

Conclusion

In Class II growing patients, the EA induces minor skeletal effects, compared to untreated control patients.

Open Access

Interlabial gap and freeway space at rest position: a cephalometric study

Published Online: 12 Oct 2021
Page range: 237 - 250

Abstract

Abstract Objectives

The aim of this prospective study was to assess the amount of interlabial gap (ILG) and freeway space (FWS) at rest position (RP) according to gender, age, and skeletal pattern, and to evaluate the cephalometric measurements at maximum intercuspal position (MIP) and at RP to define the cephalometric changes from MIP to RP related to the amount of ILG and FWS.

Methods

Lateral cephalograms and photographs of selected subjects (47 females, 57 males) were obtained at MIP and RP. Cephalometric measurements at MIP and RP and their differences were measured and compared.

Results

ILG (P > 0.05) and FWS (P < 0.01) were greater in males than in females. ILG (P < 0.05) and FWS (P > 0.05) were greater in adolescents than in adults. ILG and FWS were not significantly related with the vertical skeletal pattern (FHR, facial height ratio). ILG was the greatest in Class II cases but without significance. FWS was significantly greater in Class III than in Class I and Class II cases (P < 0.05). At MIP, the ILG at RP increased as overjet (P < 0.05) and upper lip to the aesthetic line (P < 0.01) increased. At RP, the ILG increased as upper incisor exposure and the lips to the aesthetic line increased (P < 0.001), and FWS decreased as overbite decreased (P < 0.001). From MIP to RP, lip length showed the greatest decrease (P < 0.001) in the large ILG group. Additionally, Bjork sum (the sum of the saddle, articular, and gonial angles), mandibular plane angle, anterior facial height, and ANB (P < 0.001) showed the greatest increase, while OB (P < 0.001) showed the greatest decrease in the large FWS group. The lip competent group showed the largest frequency distribution in the small ILG and FWS groups, while smile line frequency distribution showed no relationship with the level of ILG and FWS.

Conclusions

Taking cephalometric measurements at RP would be helpful to evaluate the ILG and FWS more accurately, and to provide a more accurate diagnosis and treatment plan.

Open Access

The effect of space maintainers on salivary pH, flow rate, and the oral microflora

Published Online: 01 Oct 2021
Page range: 259 - 264

Abstract

Abstract Background

Space maintainers are used to preserve created space caused by the premature loss of primary teeth but they may also upset the oral environment and play a role in caries formation. The current research aimed to assess the impact of removable and fixed space maintainers on salivary pH, flow rate, and the oral microflora.

Methods

Thirty-eight patients aged between 4 and 10 years, each of whom required a fixed (n = 19) or removable space maintainer (n = 19), were enrolled in this research. The salivary pH, saliva flow rate, salivary Streptococcus mutans, and Lactobacillus counts were measured immediately prior to the placement of the space maintainers (baseline-T0) and during the follow-up period, at the 1st (T1), 3rd (T3), and 6th (T6) month. The Wilcoxon, Mann–Whitney U test and Friedman tests were applied for statistical analyses.

Results

Streptococcus mutans and Lactobacillus counts were significantly higher at the 6th month time period in comparison with the baseline scores for both groups (P < 0.001). The salivary pH and flow rates did not change significantly at any measurement period (P > 0.05).

Conclusions

Space maintainers can favour caries formation by changing the oral microflora. It is advisable to warn patients and their parents of the risks and provide motivation to perform meticulous oral hygiene.

Open Access

A quality assessment of Internet information regarding accelerated orthodontics

Published Online: 01 Oct 2021
Page range: 265 - 272

Abstract

Abstract Objective

The aim of the present study was to evaluate the quality of information uploaded onto the Internet regarding accelerated orthodontics.

Materials and methods

The selected search terms ‘accelerated orthodontics’, ‘rapid orthodontics’, ‘speed orthodontics’, ‘rapid braces’, and ‘speed braces’ were searched by three commonly used search engines (Google, Yahoo, and Bing), and the URLs of the top 50 websites were recorded. The websites were evaluated using DISCERN, HONcode, and the Journal of the American Medical Association (JAMA) benchmark instruments. The readability of the websites was evaluated by the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level (FKGL).

Results

The total mean DISCERN score (section 1 + section 2) for all websites was 29.50/75 (range: 15–68). The average FRES of all websites was 52.99 ± 31.91. Also, the average FKGL score of all websites was 10.73 ± 2.03. Professional health organisation websites had significantly higher DISCERN scores than other websites (p < 0.001). Only three websites had the HONcode seal. Professional organisation and private dental practice websites showed better compliance with JAMA benchmarks. There was no statistically significant difference related to FRES and FKGL scores between groups (p > 0.05).

Conclusions

Information regarding accelerated orthodontics found on the Internet is insufficient. It is recommended that orthodontic societies and orthodontists increase the quality of the websites which describe accelerated orthodontics.

Open Access

The efficacy of rapid palatal expansion on the eruption of impacted maxillary canine: a systematic review

Published Online: 01 Oct 2021
Page range: 273 - 283

Abstract

Abstract Objective

The purpose of this study was to assess the current literature on the effectiveness of rapid palatal expansion (RPE) in assisting the spontaneous eruption of impacted maxillary canines.

Materials and methods

Four electronic databases were searched (Pubmed, Scopus, Web of Science, Embase) by applying appropriate Medical Subject Headings (MeSH). Two authors independently and systematically reviewed the literature. Randomised controlled trials (RCTs) and prospective controlled clinical trials (pCCTs) were identified and selected. The Cochrane Collaboration’s risk of bias tool and the risk of bias in non-randomised studies of interventions (ROBINS-I) were used to assess the quality of the obtained articles. Spontaneous canine eruption was used as a primary outcome.

Results

Three RCTs and two pCCTs met the inclusion criteria. One study was assessed at a high risk of bias in the RCT group, while the remainder were at an unclear risk of bias. Both pCCTs were classified as a moderate risk of bias based on the ROBINS-I tool. The success rate of canine eruption following RPE, with or without additional treatment, ranged from 65.7 to 85.7%, which was statistically significantly different from the control group.

Conclusion

RPE appears to improve the position of displaced maxillary canines and increase the likelihood of spontaneous eruption. However, there is a shortage of high-quality evidence to conclude that RPE can be an effective treatment option for impacted maxillary canines.

Open Access

Dentofacial changes following treatment with a fixed functional appliance and their three-dimensional effects on the upper airway

Published Online: 07 Oct 2021
Page range: 284 - 293

Abstract

Abstract Background

Proposed skeletal changes achieved by functional appliances (FA) with reference to stable structures (structural method) have received relatively little attention compared to conventional cephalometric measurements (conventional method). Using the two methods, the aims of this study were to (1) determine the skeletal changes as a result of FA treatment; and (2) identify the skeletal changes associated with upper-airway volume and minimum cross-sectional area (MCA).

Methods

Pre- and post-treatment CBCT scans were selected from 73 FA treated children (37 girls and 36 boys; mean age 12.0 years) and 73 children as a control group (matched for chronological age, skeletal age, gender, and mandibular inclination) who received orthodontic treatment using only fixed appliances (no FA). Skeletal, upper-airway volume, and MCA changes were analysed by applying both structural and conventional methods.

Results

The FA group had significant skeletal effects compared with the control group (both methods; p = 0.04 – p < 0.001). The horizontal displacement of pogonion (both methods) and the hyoid bone, together with a forward mandibular rotation (structural method), had positive effects on upper-airway volume and MCA (p < 0.05).

Conclusions

The horizontal changes in pogonion (both methods) and the hyoid bone, as well as a forward mandibular rotation (structural method), have a strong association with changes in the upper airway. The conventional method underestimates FA treatment effects. These results may influence the management of growing class II patients with compromised upper airways.

Open Access

Class II division 1 malocclusion treatment with extraction of maxillary first permanent molars: cephalometric evaluation of treatment and post-treatment changes

Published Online: 06 Oct 2021
Page range: 294 - 310

Abstract

Abstract Objective

To investigate the cephalometric outcome and post-treatment changes following the orthodontic treatment involving the extraction of maxillary first molars in patients presenting with a Class II division 1 malocclusion.

Methods

A retrospective longitudinal study was conducted involving 83 patients treated by fixed appliances and the extraction of 16 and 26. The mean age at commencement was 13.2 ± 1.5 years. Lateral cephalograms were available pre-treatment (T1), immediately post-treatment (T2), and at 2.6 years post-treatment (T3). The sample was divided into hypodivergent (n = 18), normodivergent (n = 17), and hyperdivergent (n = 48) facial types. Mean increments, standard deviations, and 95% confidence intervals were calculated for T2–T1 and T3–T2. Increments were tested using paired-samples t-tests, and variables between groups by applying ANOVA followed by Tukey’s post hoc test. Linear regression was used to examine the effect of facial type, age, and gender.

Results

Significant changes occurred during treatment for most cephalometric variables. Post-treatment, the growth pattern showed a tendency to return to the original form. Facial type had only a minor influence on cephalometric increments during and after treatment.

Conclusions

Post-treatment skeletal, soft tissue, and dentoalveolar changes were limited. Facial type had only a minor influence during and after treatment and care must be taken to control lower incisor inclination.

Open Access

The prevalence of posterior tongue tie in patients with transverse maxillary deficiency

Published Online: 19 Oct 2021
Page range: 294 - 300

Abstract

Abstract Objectives

To investigate the prevalence of posterior tongue tie in orthodontic patients using numerical and clinical assessment methods in order to identify an association between posterior tongue tie and transverse maxillary deficiency.

Materials and methods

Seventy-nine participants from an orthodontic clinic were divided into two groups. The first group of 44 patients exhibited a skeletally narrow maxilla and required maxillary skeletal expansion (MSE group) and 35 patients without a transverse discrepancy comprised a control group. Posterior tongue tie was examined by the Kotlow tongue tie classification, tongue range of motion ratio (TRMR) and via a clinical assessment. The prevalence of posterior tongue tie was compared between the two groups.

Results

There was no significant difference in the level of the Kotlow classification grade between the two groups (p > 0.05) and the overall majority was diagnosed as normal. However, a higher proportion of posterior tongue tie was found in the MSE group than in the control group by clinical assessment (MSE group, 72.7%; control group, 42.9%; p = 0.005). The proportion of TRMR grade 2 was also higher in the MSE group than in the control group (p = 0.001). Of the subjects diagnosed with posterior tongue tie by clinical findings, approximately 94% showed TRMR grades 2 or 3.

Conclusions

A clinical assessment of posterior tongue tie was found to be simple and accurate, whereas a numerical assessment alone provided diagnostic difficulty. Considering the high prevalence of observed posterior tongue tie in the MSE group, there was a significant association between posterior tongue tie and transverse maxillary deficiency.

Open Access

Treatment of mandibular second molar impaction in a patient with metal hypersensitivity

Published Online: 20 Oct 2021
Page range: 313 - 320

Abstract

Abstract

It is widely accepted that the prevalence of metal hypersensitivity is increasing. Furthermore, the incidence of unerupted mandibular second molars is 2.3%, of which 0.2% is judged to be a result of impaction. While it is becoming more common to treat impacted mandibular second molars in daily clinical practice, metal hypersensitive patients presenting with unerupted molars are less frequently encountered. There have been no previous reports of patients who required mandibular molar traction and who also suffered from metal hypersensitivity. Therefore, this is the first case report to describe the long-term stability of mandibular second molar dis-impaction, leading to high level of patient satisfaction.

Open Access

Unilateral Brodie bite correction in a growing patient using palatal and buccal miniscrews: A case report

Published Online: 19 Oct 2021
Page range: 301 - 312

Abstract

Abstract

This case report describes a 13-year-old Caucasian male who presented with a Class I dental relationship on a mild Class II skeletal base and an associated unilateral Brodie bite on the right side but an ideal anterior overjet and overbite. The posterior teeth in the first quadrant had supra-erupted due to a lack of opposing occlusion. The treatment comprised two phases, the first of which involved miniscrew-based intrusion of the maxillary right buccal teeth followed by non-extraction, full upper and lower pre-adjusted edgewise appliances during a second phase. A satisfactory occlusal result was achieved in 24 months.

Open Access

The appeal of ‘Do It Yourself’ orthodontic aligners: A YouTube analysis

Published Online: 28 Oct 2021
Page range: 321 - 332

Abstract

Abstract

Objective: The present study aimed to determine how the popularity of ‘Do It Yourself’ (DIY) aligner videos available on YouTube relates to authorship, video content, quality and reliability, and to determine why DIY aligners appeal to consumers.

Methods: The Google Trends website was interrogated to identify the most frequently used search terms regarding DIY aligners which were subsequently applied to a search of the YouTube website. One hundred twenty-three videos were assessed for completeness of content, reliability (using a modified version of the DISCERN tool) and quality using the Global Quality Score (GQS). The relationship between the variables and authorship, popularity, financial interest, and recommendations were assessed using Pearson Correlation Coefficients.

Results: Laypeople produced the majority of the videos (73%). Dentists/Orthodontists uploaded only 4% of the videos, and dental professional bodies uploaded none. Most videos (86%) were content poor, unreliable (average DISCERN score of 1) and of low quality (average GQS of 2). The more popular, reliable and superior the quality of the video, the greater the number of views, likes and viewing rate (p < 0.05). Conversely, authors with a financial interest and lower quality and less reliable videos were more likely to recommend DIY aligners. Consumers sought DIY aligner treatment due to a reduced cost.

Conclusions: YouTube should not be considered as a viable nor reliable source of DIY aligner information for patients or the public. Dentists/Orthodontists should be encouraged to publish comprehensive and more informative YouTube content related to DIY aligners.

Open Access

Cortical bone microdamage produced by micro-osteoperforation screws versus orthodontic miniscrews: an in vitro study

Published Online: 28 Oct 2021
Page range: 333 - 341

Abstract

Abstract Background/objective

The alternative use of Orthodontic Miniscrew Implants (OMIs), traditionally used for skeletal anchorage, to facilitate micro-osteoperforations (MOPs) for accelerating orthodontic tooth movement has been reported in previous studies. The objective of the present in vitro study was to compare the microdamage generated by OMIs and MOP-purposed screws of similar dimensions in porcine cortical bone.

Materials and methods

Forty rectangular porcine cortical bone specimens of 1.5 mm thickness were produced and divided into two equal groups. According to group allocation, either a single MOP screw or OMI was inserted and later removed. A sequential staining protocol was carried out to distinguish true microdamage created upon screw insertion and removal from iatrogenic damage. The bone specimens were imaged by a confocal laser scanning microscope, and five histomorphometric measurements described and quantified the generated microdamage.

Results

On the entry (outer) bone surface, the OMI screws produced greater microdamage which reached statistical significance across all of the histomorphometric parameters. In contrast, a statistically significant increase in microdamage was created following MOP screw insertion on the exit (inner) bone surface, but only in three assessment parameters, recorded as total damage area, as well as diffuse damage area and radius.

Conclusions

Overall, the present study showed that 1.5 mm OMIs produced slightly greater microcrack-type and diffuse damage-type microdamage than the 1.6 mm diameter MOP screws. However, these differences were small and considered clinically insignificant.

Open Access

Incidence of lateral incisor root resorption associated with impacted maxillary canines

Published Online: 08 Dec 2021
Page range: 352 - 359

Abstract

Abstract Introduction

The aim of this study was to determine the incidence of lateral incisor root resorption associated with impacted maxillary canines and determine predisposing factors that may be used to predict its occurrence.

Methods

Cone beam computerised tomographic images of 133 patients presenting with 186 impacted canines were examined for lateral incisor root resorption. A control sample consisted of 30 lateral incisors on the side of the non-impacted canine. The studied canine-associated variables were gender, type of impaction, location of the canine both meso-distally and vertically and the long axis angulation to the midline. Axial images were primarily used to diagnose resorption.

Results

The estimated percentage of lateral root resorption in the sample was 17% (range 11.8– 23.9%) confirmed at a 95% confidence interval. A significant association was observed between the level of overlap of the canine across the lateral incisor, measured in sectors, and the probability of lateral incisor root resorption. The probability approximately doubled for each additional sector of canine overlap. No other significant association was noted related to all the other variables examined.

Conclusions

The incidence of lateral incisor root resorption associated with impacted maxillary canines was lower in the present study compared with many previous reports. However, resorption remains a common clinical finding. In order to screen for lateral incisor resorption, it is recommended that a cone beam image be prescribed when there is a mesial overlap of an impacted canine across the lateral incisor midline.

Open Access

Editorial

Published Online: 13 Dec 2021
Page range: 360 - 361

Abstract

Open Access

The clinical fabrication of polyolefin mouthguards formed over fixed orthodontic appliances

Published Online: 13 Dec 2021
Page range: 362 - 366

Abstract

Abstract

Using a new polyolefin material without impressions and models, fifty-two mouthguards were fabricated at chairside by a dental professional. Patient acceptance, operator assessment, mouthguard retention and fabrication time were assessed. The study demonstrated the practicality of custom-made mouthguard fabrication over fixed orthodontic appliances and recommends the procedure as a useful adjunct to orthodontic practice.

Open Access

Multidisciplinary treatment from infancy to adolescence of a patient with a unilateral cleft lip and palate: a 16-year follow-up case report

Published Online: 13 Dec 2021
Page range: 367 - 378

Abstract

Abstract

Cleft lip and palate (CLP) are conditions that require long-term management and review from infancy to adolescence. Surgical procedures become easier when nasoalveolar moulding (NAM) measures are applied during the neonatal period. Orthodontic treatment provided for these patients during the progressive dentition developmental periods can achieve positive aesthetic and functional results. In patients affected by a CLP, the lateral incisor in the cleft region is usually missing and multidisciplinary prosthodontic rehabilitation of the edentulous space is often required. In the present case report, positive results of NAM, coupled with orthodontic and prosthodontic treatment are presented for a CLP patient who began management during the neonatal period. In addition, a minimally invasive aesthetic restoration is presented as a solution for the prosthodontic rehabilitation of a missing lateral incisor.

25 Articles
Open Access

Efficacy of fluoride varnish in treating orthodontically-induced white spot lesions: a systematic review and meta-analysis

Published Online: 21 Oct 2021
Page range: 147 - 156

Abstract

Abstract Objectives

To systematically review the effectiveness of 5% sodium fluoride varnish (FV) in the treatment of orthodontically-induced white spot lesions (WSLs).

Methods

A literature search of three independent databases (Medline, Cochrane Library and Web of Science) was performed from inception to November 2020. This systematic review included randomised/quasi-randomised clinical trials (RCTs) that used FV for patients who had at least one WSL as a result of fixed orthodontic treatment. Exclusion criteria were split-mouth study designs or studies that failed to report WSLs as the outcome variable or studies with less than 3 months follow-up. An Inverse-Variance fixed-effect method was performed for continuous variables. Changes in the mean difference (MD) for the DIAGNOdent (DD) scores following FV application were calculated at the 95% confidence interval (CI).

Results

Three of the four included studies showed significant improvement in the remineralisation of WSL after treatment with FV in comparison to control subjects. Three studies were conducted on patients after fixed orthodontic treatment and one study was conducted during treatment. The studies included a total of 284 participants with the majority in the age range of 10 to 25 years. The distribution of the participants was approximately equal in the FV and control group. When compared with the control group, there was a statistically significant reduction in the mean DD readings for the FV group at the 3-month (MD = -3.43; 95% CI: -4.72 to -2.15; p < 0.001) and at the 6-month (MD = -4.47; 95% CI: -4.72 to -2.15; p < 0.001) follow-up visit.

Conclusions

Although few studies have shown the effectiveness of FV application in the treatment of orthodontically-induced WSLs, the limited number of robust clinical trials, makes it difficult to draw a definitive conclusion.

Open Access

Pulp chamber temperature changes during orthodontic bonding – an in vitro study

Published Online: 21 Oct 2021
Page range: 157 - 164

Abstract

Abstract Aim

Using a thermal camera, the aim of the study was to determine pulp chamber temperature changes during orthodontic bonding produced as a result of variations in curing light sources, different curing distances and bracket types.

Methods

One hundred sixty maxillary premolar teeth were sectioned into two halves and embedded into acrylic moulds. Four curing light sources were used which further divided the overall sample into Halogen, light emitting diode (LED), powered LED, and high-power LED groups. Additional subgroups were created according to the applied curing distances (5 mm, 10 mm) and different bracket types (metallic or ceramic). A standardised bonding procedure was performed and pulp chamber temperature changes were evaluated using a thermal camera. Statistical analysis was performed using a three-way ANOVA.

Results

The Halogen light curing group revealed a significantly higher temperature rise in the pulp chamber compared to the other groups. A shorter curing distance produced increases in pulpal temperature. There was no significant effect as a result of the bracket type.

Conclusions

None of the curing light sources exceeded the critical value for pulp chamber temperature rise. The primary desirable outcome was the lowest temperature increase noted with the high-power LED unit. The secondary outcome related to the different brackets revealed no difference relative to pulp chamber temperature change. From a clinical perspective, high-power LED units could be safely used.

Open Access

The role of micro-implant-assisted rapid palatal expansion (MARPE) in clinical orthodontics — a literature review

Published Online: 21 Oct 2021
Page range: 206 - 216

Abstract

Abstract

A maxillary transverse deficiency is a common craniofacial problem. Rapid palatal expansion (RPE) has been traditionally considered for the treatment of children and young adolescents, but this is not applicable in late adolescents or adults due to the ossification of facial sutures. A surgically assisted rapid palatal expansion (SARPE) was initially advocated for this group of patients, but the surgical procedure is associated with morbidity. As temporary anchorage devices (TADs) have been recently and popularly applied in clinical orthodontics, micro-implant-assisted rapid palatal expansion (MARPE) has been employed to facilitate maxillary expansion in skeletally mature patients. There have been various proposed MARPE designs and the outcomes appear promising. The aim of the present article is to discuss the role of MARPE in clinical orthodontics by reviewing its background, design, indications, treatment effects, stability, and limitations in the current literature. The treatment effects of two types of MARPE, bone-borne and tooth-bone-borne (hybrid), will be individually assessed.

Open Access

Quantitative assessment of interproximal tooth reduction performed as part of Invisalign® treatment in 10 orthodontic practices

Published Online: 21 Oct 2021
Page range: 176 - 186

Abstract

Abstract Background

Interproximal reduction (IPR) is a treatment option for orthodontic space gain. The attainment of prescribed objectives in aligner treatment may require IPR that is accurately performed both qualitatively and quantitatively.

Objective

This study assesses the in vivo accuracy of IPR carried out in 10 orthodontic practices as a method of orthodontic space creation.

Methods

A comparison of proposed and achieved amounts of IPR completed (accuracy), the accuracy of IPR within and between upper and lower dental arches, and the accuracy of IPR within and between posterior and anterior arch segments were performed using 3-dimensional digital study models gained via Align’s® ClinCheck.

Results

The findings indicated that IPR was routinely underperformed by all practices studied. On average, the amount of IPR achieved represented only 44.0% of the total prescribed per tooth in the sample assessed, with a mean discrepancy of 0.16 mm per tooth. There were statistically significant differences only between the overall anterior and posterior groups (p < 0.01) and between maxillary anterior and maxillary posterior groups (p < 0.01); however, these were not clinically significant. Significant differences in IPR performance were noted between different orthodontic practices.

Conclusions

This study demonstrates that the clinical performance of IPR in 10 orthodontic practices consistently fails to achieve the prescribed amount often by large variations. The effect of this under-performance on clinical outcomes remains to be quantified.

Open Access

Perception of dental midline deviation and smile attractiveness by eye-tracking and aesthetic ratings

Published Online: 21 Oct 2021
Page range: 187 - 196

Abstract

Abstract Aim

To evaluate the perception of smile aesthetics and midline deviation considered by orthodontists (ORT), dentists (DT), patient’s-relatives (PR), and laypersons (LP) using an eye-tracking device and survey.

Methods

The study invited the participation of 42 orthodontists, 51 dentists, 50 patient-relatives, and 52 laypersons. A posed smile photograph of a female was chosen as a base image. The dental midline (DML) was digitally moved 1 mm (DML1R, DML1L), 2 mm (DML2R, DML2L), 3 mm (DML3R, DML3L), and 4 mm (DML4R, DML4L) on the base image’s right (DMLR) and left (DMLL) segments. Eight modified images were subsequently obtained. The base, modified, and repeated images were randomly arranged and uploaded into the Tobii Pro Lab software program for assessment by the participants. An eye-tracking dataset included first fixation duration (FFD), total fixation duration (TFD), and visit counts (VC). The participants also evaluated the photographs on the survey forms via a Visual Analogue Scale (VAS) and a Likert scale. The intra-group relations and inter-group correlations were evaluated statistically.

Results

The TFD for the DML2R photograph was found to be statistically significant between the assessment groups (p = 0.026). While the longest fixation time (0.93 sec) belonged to the orthodontists, it was observed that the patient relatives had the shortest fixation time (0.51 sec). The VAS score for the DML2R image was found to be highest in laypersons (p < 0.001). In general, the survey scores of the patient relatives and laypersons were higher.

Conclusion

The fixation time between the participant groups increased when there was a 2 mm deviation. A 2 mm shift in the DML was noticed by all participant groups and was considered unaesthetic.

Open Access

Multidisciplinary management of an adult skeletal Class III patient with generalized aggressive periodontitis and canine-premolar transposition

Published Online: 21 Oct 2021
Page range: 165 - 175

Abstract

Abstract

This case report presents orthodontic camouflage treatment and the correction of transposed canine-first premolar teeth in a patient who presented with a skeletal Class III and familial periodontal problem. A 28-year-old female patient who was diagnosed with generalised aggressive periodontitis was treated by scaling and root planing plus the adjunctive use of systemic antibiotics and surgical therapy prior to referral to the orthodontic department. After the progression of the disease was controlled, orthodontic treatment was commenced to correct the dental transposition by using a modified Nance-TPA appliance and sectional arch mechanics. A non-extraction orthodontic camouflage treatment was planned to eliminate the anterior crossbite and to establish a proper occlusion by closing the multiple diastemata. Treatment outcomes remained stable in the 2-year follow-up period. Severe orthodontic-periodontal problems can be successfully treated by oral hygiene motivation, an interdisciplinary approach, and the selection of appropriate biomechanics.

Open Access

A national survey of orthodontists in Malaysia and their use of functional appliances for Class II malocclusions

Published Online: 12 Oct 2021
Page range: 217 - 226

Abstract

Abstract Objectives

The aim of this study was to evaluate the use of functional appliances by the currently practising orthodontists in Malaysia. The objectives were to identify the different types of functional appliances used by Malaysian orthodontists and to investigate the variation in treatment protocols when attempting growth modification.

Methods

An online questionnaire consisting of 24 open-ended and multiple-choice questions was emailed to members of the Malaysian Association of Orthodontists (MAO) (n = 183). The survey was based on a previous study conducted by members of the British Orthodontic Society and was modified to suit the Malaysian population. The data were analysed using SPSS to generate frequency tables and descriptive statistics.

Results

Seventy-two responses were received from current Malaysian orthodontists. Of the respondents, 71% practised in a government setting and 29% were in private practice. The Clark Twin Block was the most frequently used functional appliance by 90% of Malaysian orthodontists. Many of the respondents (57%) prescribed full-time wear of removable functional appliances for 6–9 months (except during mealtimes) (51%). Following active removable functional appliance therapy, 91% prescribed a period of retention which involved a reduction in the duration of wear. The retention phase extended for 2 to 3 months (41%) or for 4 to 6 months (39%) for the majority of the respondents.

Conclusions

The Clark Twin Block is the most frequently-used functional appliance for the management of a Class II malocclusion by orthodontists currently practising in Malaysia.

Open Access

Class III malocclusion: a challenging treatment using miniscrews for extra anchorage

Published Online: 12 Oct 2021
Page range: 227 - 236

Abstract

Abstract Aims

This article presents the nonsurgical orthodontic treatment of a skeletal Class III malocclusion of an adult patient.

Methods

Because the patient refused an orthognathic surgical procedure, the mandibular first premolars were extracted and orthodontic camouflage using miniscrew anchorage was used to correct dental asymmetries and the occlusal relationship.

Results

The treatment strategy was successful and provided an acceptable aesthetic functional occlusion.

Conclusion

When appropriately indicated, the orthodontic camouflage of a class III malocclusion can avoid orthognathic surgery and, through the use of mini-implants as skeletal anchorage, enhance the results.

Open Access

The risk for paediatric obstructive sleep apnoea in rural Queensland

Published Online: 12 Oct 2021
Page range: 197 - 205

Abstract

Abstract Background

The importance of assessing patients for paediatric obstructive sleep apnoea (OSA) cannot be more highly stressed and orthodontists may play an essential role in risk screening. The Paediatric Sleep Questionnaire (PSQ) is a validated tool to identify whether a child is at risk for paediatric OSA.

Objectives

The likelihood of paediatric OSA in school-aged children residing in Far North Queensland (FNQ) will be assessed using the PSQ.

Methods

Parents of children aged between 4 and 18 years were invited to participate through schools and social media messaging to complete an online PSQ questionnaire to assess their OSA risk and demographics.

Results

The final sample consisted of 404 school-aged children of whom 62.5% were found to be at a high-risk for paediatric OSA. The high risk was significantly associated with males and those of overweight/obese BMI status (p < 0.001). Race and age were not significant associations (p > 0.05).

Conclusions

Within the contributing sample of school-aged children in FNQ, a significant number were found to be at high-risk of paediatric OSA. Males and overweight/obese children were measured risk factors.

Open Access

Cephalometric effects of the elastodontic appliance in managing skeletal Class II division 1 cases

Published Online: 01 Oct 2021
Page range: 251 - 258

Abstract

Abstract Aim

The aim of the study was to evaluate the cephalometric effects of the elastodontic appliance (EA) in the management of patients presenting with a skeletal Class II/1 malocclusion.

Methods

Twenty Class II patients treated using the EA (Group EA) were compared with 20 Class II untreated children (Group C). Cephalograms were compared at the start (T0) and after 24 months (T1) after which time, skeletal, dental, and aesthetic variables were evaluated. A statistical evaluation was conducted by applying an unpaired t-test for normally distributed variables.

Results

From T0 to T1, the EA group showed a significant increase in lower facial height (LFH), in mandibular length (Co-Gn), in the upper incisor and cranial plane angle (1 + SN) and in the distance between a true vertical line (TVL)-soft tissue B (B’) and TVL-soft tissue Pogonion (Pog’) points. From T0 to T1, group C showed a significant decrease in SN-occlusal plane (PO) (p < 0.01), of SN-mandibular plane (Go-Me) (p < 0.01) and of total gonial (N-Go-Me) angles (p < 0.05); a significant reduction of the distance between TVL-upper incisor (1+), TVL-lower lip (Li), and TVL-Pog’ was shown. No statistical differences were observed between the groups in dental and aesthetic outcomes, except for a skeletal increase in LFH (p < 0.05) and in Co-Gn length (p < 0.05), which was statistically significant in the EA group.

Conclusion

In Class II growing patients, the EA induces minor skeletal effects, compared to untreated control patients.

Open Access

Interlabial gap and freeway space at rest position: a cephalometric study

Published Online: 12 Oct 2021
Page range: 237 - 250

Abstract

Abstract Objectives

The aim of this prospective study was to assess the amount of interlabial gap (ILG) and freeway space (FWS) at rest position (RP) according to gender, age, and skeletal pattern, and to evaluate the cephalometric measurements at maximum intercuspal position (MIP) and at RP to define the cephalometric changes from MIP to RP related to the amount of ILG and FWS.

Methods

Lateral cephalograms and photographs of selected subjects (47 females, 57 males) were obtained at MIP and RP. Cephalometric measurements at MIP and RP and their differences were measured and compared.

Results

ILG (P > 0.05) and FWS (P < 0.01) were greater in males than in females. ILG (P < 0.05) and FWS (P > 0.05) were greater in adolescents than in adults. ILG and FWS were not significantly related with the vertical skeletal pattern (FHR, facial height ratio). ILG was the greatest in Class II cases but without significance. FWS was significantly greater in Class III than in Class I and Class II cases (P < 0.05). At MIP, the ILG at RP increased as overjet (P < 0.05) and upper lip to the aesthetic line (P < 0.01) increased. At RP, the ILG increased as upper incisor exposure and the lips to the aesthetic line increased (P < 0.001), and FWS decreased as overbite decreased (P < 0.001). From MIP to RP, lip length showed the greatest decrease (P < 0.001) in the large ILG group. Additionally, Bjork sum (the sum of the saddle, articular, and gonial angles), mandibular plane angle, anterior facial height, and ANB (P < 0.001) showed the greatest increase, while OB (P < 0.001) showed the greatest decrease in the large FWS group. The lip competent group showed the largest frequency distribution in the small ILG and FWS groups, while smile line frequency distribution showed no relationship with the level of ILG and FWS.

Conclusions

Taking cephalometric measurements at RP would be helpful to evaluate the ILG and FWS more accurately, and to provide a more accurate diagnosis and treatment plan.

Open Access

The effect of space maintainers on salivary pH, flow rate, and the oral microflora

Published Online: 01 Oct 2021
Page range: 259 - 264

Abstract

Abstract Background

Space maintainers are used to preserve created space caused by the premature loss of primary teeth but they may also upset the oral environment and play a role in caries formation. The current research aimed to assess the impact of removable and fixed space maintainers on salivary pH, flow rate, and the oral microflora.

Methods

Thirty-eight patients aged between 4 and 10 years, each of whom required a fixed (n = 19) or removable space maintainer (n = 19), were enrolled in this research. The salivary pH, saliva flow rate, salivary Streptococcus mutans, and Lactobacillus counts were measured immediately prior to the placement of the space maintainers (baseline-T0) and during the follow-up period, at the 1st (T1), 3rd (T3), and 6th (T6) month. The Wilcoxon, Mann–Whitney U test and Friedman tests were applied for statistical analyses.

Results

Streptococcus mutans and Lactobacillus counts were significantly higher at the 6th month time period in comparison with the baseline scores for both groups (P < 0.001). The salivary pH and flow rates did not change significantly at any measurement period (P > 0.05).

Conclusions

Space maintainers can favour caries formation by changing the oral microflora. It is advisable to warn patients and their parents of the risks and provide motivation to perform meticulous oral hygiene.

Open Access

A quality assessment of Internet information regarding accelerated orthodontics

Published Online: 01 Oct 2021
Page range: 265 - 272

Abstract

Abstract Objective

The aim of the present study was to evaluate the quality of information uploaded onto the Internet regarding accelerated orthodontics.

Materials and methods

The selected search terms ‘accelerated orthodontics’, ‘rapid orthodontics’, ‘speed orthodontics’, ‘rapid braces’, and ‘speed braces’ were searched by three commonly used search engines (Google, Yahoo, and Bing), and the URLs of the top 50 websites were recorded. The websites were evaluated using DISCERN, HONcode, and the Journal of the American Medical Association (JAMA) benchmark instruments. The readability of the websites was evaluated by the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level (FKGL).

Results

The total mean DISCERN score (section 1 + section 2) for all websites was 29.50/75 (range: 15–68). The average FRES of all websites was 52.99 ± 31.91. Also, the average FKGL score of all websites was 10.73 ± 2.03. Professional health organisation websites had significantly higher DISCERN scores than other websites (p < 0.001). Only three websites had the HONcode seal. Professional organisation and private dental practice websites showed better compliance with JAMA benchmarks. There was no statistically significant difference related to FRES and FKGL scores between groups (p > 0.05).

Conclusions

Information regarding accelerated orthodontics found on the Internet is insufficient. It is recommended that orthodontic societies and orthodontists increase the quality of the websites which describe accelerated orthodontics.

Open Access

The efficacy of rapid palatal expansion on the eruption of impacted maxillary canine: a systematic review

Published Online: 01 Oct 2021
Page range: 273 - 283

Abstract

Abstract Objective

The purpose of this study was to assess the current literature on the effectiveness of rapid palatal expansion (RPE) in assisting the spontaneous eruption of impacted maxillary canines.

Materials and methods

Four electronic databases were searched (Pubmed, Scopus, Web of Science, Embase) by applying appropriate Medical Subject Headings (MeSH). Two authors independently and systematically reviewed the literature. Randomised controlled trials (RCTs) and prospective controlled clinical trials (pCCTs) were identified and selected. The Cochrane Collaboration’s risk of bias tool and the risk of bias in non-randomised studies of interventions (ROBINS-I) were used to assess the quality of the obtained articles. Spontaneous canine eruption was used as a primary outcome.

Results

Three RCTs and two pCCTs met the inclusion criteria. One study was assessed at a high risk of bias in the RCT group, while the remainder were at an unclear risk of bias. Both pCCTs were classified as a moderate risk of bias based on the ROBINS-I tool. The success rate of canine eruption following RPE, with or without additional treatment, ranged from 65.7 to 85.7%, which was statistically significantly different from the control group.

Conclusion

RPE appears to improve the position of displaced maxillary canines and increase the likelihood of spontaneous eruption. However, there is a shortage of high-quality evidence to conclude that RPE can be an effective treatment option for impacted maxillary canines.

Open Access

Dentofacial changes following treatment with a fixed functional appliance and their three-dimensional effects on the upper airway

Published Online: 07 Oct 2021
Page range: 284 - 293

Abstract

Abstract Background

Proposed skeletal changes achieved by functional appliances (FA) with reference to stable structures (structural method) have received relatively little attention compared to conventional cephalometric measurements (conventional method). Using the two methods, the aims of this study were to (1) determine the skeletal changes as a result of FA treatment; and (2) identify the skeletal changes associated with upper-airway volume and minimum cross-sectional area (MCA).

Methods

Pre- and post-treatment CBCT scans were selected from 73 FA treated children (37 girls and 36 boys; mean age 12.0 years) and 73 children as a control group (matched for chronological age, skeletal age, gender, and mandibular inclination) who received orthodontic treatment using only fixed appliances (no FA). Skeletal, upper-airway volume, and MCA changes were analysed by applying both structural and conventional methods.

Results

The FA group had significant skeletal effects compared with the control group (both methods; p = 0.04 – p < 0.001). The horizontal displacement of pogonion (both methods) and the hyoid bone, together with a forward mandibular rotation (structural method), had positive effects on upper-airway volume and MCA (p < 0.05).

Conclusions

The horizontal changes in pogonion (both methods) and the hyoid bone, as well as a forward mandibular rotation (structural method), have a strong association with changes in the upper airway. The conventional method underestimates FA treatment effects. These results may influence the management of growing class II patients with compromised upper airways.

Open Access

Class II division 1 malocclusion treatment with extraction of maxillary first permanent molars: cephalometric evaluation of treatment and post-treatment changes

Published Online: 06 Oct 2021
Page range: 294 - 310

Abstract

Abstract Objective

To investigate the cephalometric outcome and post-treatment changes following the orthodontic treatment involving the extraction of maxillary first molars in patients presenting with a Class II division 1 malocclusion.

Methods

A retrospective longitudinal study was conducted involving 83 patients treated by fixed appliances and the extraction of 16 and 26. The mean age at commencement was 13.2 ± 1.5 years. Lateral cephalograms were available pre-treatment (T1), immediately post-treatment (T2), and at 2.6 years post-treatment (T3). The sample was divided into hypodivergent (n = 18), normodivergent (n = 17), and hyperdivergent (n = 48) facial types. Mean increments, standard deviations, and 95% confidence intervals were calculated for T2–T1 and T3–T2. Increments were tested using paired-samples t-tests, and variables between groups by applying ANOVA followed by Tukey’s post hoc test. Linear regression was used to examine the effect of facial type, age, and gender.

Results

Significant changes occurred during treatment for most cephalometric variables. Post-treatment, the growth pattern showed a tendency to return to the original form. Facial type had only a minor influence on cephalometric increments during and after treatment.

Conclusions

Post-treatment skeletal, soft tissue, and dentoalveolar changes were limited. Facial type had only a minor influence during and after treatment and care must be taken to control lower incisor inclination.

Open Access

The prevalence of posterior tongue tie in patients with transverse maxillary deficiency

Published Online: 19 Oct 2021
Page range: 294 - 300

Abstract

Abstract Objectives

To investigate the prevalence of posterior tongue tie in orthodontic patients using numerical and clinical assessment methods in order to identify an association between posterior tongue tie and transverse maxillary deficiency.

Materials and methods

Seventy-nine participants from an orthodontic clinic were divided into two groups. The first group of 44 patients exhibited a skeletally narrow maxilla and required maxillary skeletal expansion (MSE group) and 35 patients without a transverse discrepancy comprised a control group. Posterior tongue tie was examined by the Kotlow tongue tie classification, tongue range of motion ratio (TRMR) and via a clinical assessment. The prevalence of posterior tongue tie was compared between the two groups.

Results

There was no significant difference in the level of the Kotlow classification grade between the two groups (p > 0.05) and the overall majority was diagnosed as normal. However, a higher proportion of posterior tongue tie was found in the MSE group than in the control group by clinical assessment (MSE group, 72.7%; control group, 42.9%; p = 0.005). The proportion of TRMR grade 2 was also higher in the MSE group than in the control group (p = 0.001). Of the subjects diagnosed with posterior tongue tie by clinical findings, approximately 94% showed TRMR grades 2 or 3.

Conclusions

A clinical assessment of posterior tongue tie was found to be simple and accurate, whereas a numerical assessment alone provided diagnostic difficulty. Considering the high prevalence of observed posterior tongue tie in the MSE group, there was a significant association between posterior tongue tie and transverse maxillary deficiency.

Open Access

Treatment of mandibular second molar impaction in a patient with metal hypersensitivity

Published Online: 20 Oct 2021
Page range: 313 - 320

Abstract

Abstract

It is widely accepted that the prevalence of metal hypersensitivity is increasing. Furthermore, the incidence of unerupted mandibular second molars is 2.3%, of which 0.2% is judged to be a result of impaction. While it is becoming more common to treat impacted mandibular second molars in daily clinical practice, metal hypersensitive patients presenting with unerupted molars are less frequently encountered. There have been no previous reports of patients who required mandibular molar traction and who also suffered from metal hypersensitivity. Therefore, this is the first case report to describe the long-term stability of mandibular second molar dis-impaction, leading to high level of patient satisfaction.

Open Access

Unilateral Brodie bite correction in a growing patient using palatal and buccal miniscrews: A case report

Published Online: 19 Oct 2021
Page range: 301 - 312

Abstract

Abstract

This case report describes a 13-year-old Caucasian male who presented with a Class I dental relationship on a mild Class II skeletal base and an associated unilateral Brodie bite on the right side but an ideal anterior overjet and overbite. The posterior teeth in the first quadrant had supra-erupted due to a lack of opposing occlusion. The treatment comprised two phases, the first of which involved miniscrew-based intrusion of the maxillary right buccal teeth followed by non-extraction, full upper and lower pre-adjusted edgewise appliances during a second phase. A satisfactory occlusal result was achieved in 24 months.

Open Access

The appeal of ‘Do It Yourself’ orthodontic aligners: A YouTube analysis

Published Online: 28 Oct 2021
Page range: 321 - 332

Abstract

Abstract

Objective: The present study aimed to determine how the popularity of ‘Do It Yourself’ (DIY) aligner videos available on YouTube relates to authorship, video content, quality and reliability, and to determine why DIY aligners appeal to consumers.

Methods: The Google Trends website was interrogated to identify the most frequently used search terms regarding DIY aligners which were subsequently applied to a search of the YouTube website. One hundred twenty-three videos were assessed for completeness of content, reliability (using a modified version of the DISCERN tool) and quality using the Global Quality Score (GQS). The relationship between the variables and authorship, popularity, financial interest, and recommendations were assessed using Pearson Correlation Coefficients.

Results: Laypeople produced the majority of the videos (73%). Dentists/Orthodontists uploaded only 4% of the videos, and dental professional bodies uploaded none. Most videos (86%) were content poor, unreliable (average DISCERN score of 1) and of low quality (average GQS of 2). The more popular, reliable and superior the quality of the video, the greater the number of views, likes and viewing rate (p < 0.05). Conversely, authors with a financial interest and lower quality and less reliable videos were more likely to recommend DIY aligners. Consumers sought DIY aligner treatment due to a reduced cost.

Conclusions: YouTube should not be considered as a viable nor reliable source of DIY aligner information for patients or the public. Dentists/Orthodontists should be encouraged to publish comprehensive and more informative YouTube content related to DIY aligners.

Open Access

Cortical bone microdamage produced by micro-osteoperforation screws versus orthodontic miniscrews: an in vitro study

Published Online: 28 Oct 2021
Page range: 333 - 341

Abstract

Abstract Background/objective

The alternative use of Orthodontic Miniscrew Implants (OMIs), traditionally used for skeletal anchorage, to facilitate micro-osteoperforations (MOPs) for accelerating orthodontic tooth movement has been reported in previous studies. The objective of the present in vitro study was to compare the microdamage generated by OMIs and MOP-purposed screws of similar dimensions in porcine cortical bone.

Materials and methods

Forty rectangular porcine cortical bone specimens of 1.5 mm thickness were produced and divided into two equal groups. According to group allocation, either a single MOP screw or OMI was inserted and later removed. A sequential staining protocol was carried out to distinguish true microdamage created upon screw insertion and removal from iatrogenic damage. The bone specimens were imaged by a confocal laser scanning microscope, and five histomorphometric measurements described and quantified the generated microdamage.

Results

On the entry (outer) bone surface, the OMI screws produced greater microdamage which reached statistical significance across all of the histomorphometric parameters. In contrast, a statistically significant increase in microdamage was created following MOP screw insertion on the exit (inner) bone surface, but only in three assessment parameters, recorded as total damage area, as well as diffuse damage area and radius.

Conclusions

Overall, the present study showed that 1.5 mm OMIs produced slightly greater microcrack-type and diffuse damage-type microdamage than the 1.6 mm diameter MOP screws. However, these differences were small and considered clinically insignificant.

Open Access

Incidence of lateral incisor root resorption associated with impacted maxillary canines

Published Online: 08 Dec 2021
Page range: 352 - 359

Abstract

Abstract Introduction

The aim of this study was to determine the incidence of lateral incisor root resorption associated with impacted maxillary canines and determine predisposing factors that may be used to predict its occurrence.

Methods

Cone beam computerised tomographic images of 133 patients presenting with 186 impacted canines were examined for lateral incisor root resorption. A control sample consisted of 30 lateral incisors on the side of the non-impacted canine. The studied canine-associated variables were gender, type of impaction, location of the canine both meso-distally and vertically and the long axis angulation to the midline. Axial images were primarily used to diagnose resorption.

Results

The estimated percentage of lateral root resorption in the sample was 17% (range 11.8– 23.9%) confirmed at a 95% confidence interval. A significant association was observed between the level of overlap of the canine across the lateral incisor, measured in sectors, and the probability of lateral incisor root resorption. The probability approximately doubled for each additional sector of canine overlap. No other significant association was noted related to all the other variables examined.

Conclusions

The incidence of lateral incisor root resorption associated with impacted maxillary canines was lower in the present study compared with many previous reports. However, resorption remains a common clinical finding. In order to screen for lateral incisor resorption, it is recommended that a cone beam image be prescribed when there is a mesial overlap of an impacted canine across the lateral incisor midline.

Open Access

Editorial

Published Online: 13 Dec 2021
Page range: 360 - 361

Abstract

Open Access

The clinical fabrication of polyolefin mouthguards formed over fixed orthodontic appliances

Published Online: 13 Dec 2021
Page range: 362 - 366

Abstract

Abstract

Using a new polyolefin material without impressions and models, fifty-two mouthguards were fabricated at chairside by a dental professional. Patient acceptance, operator assessment, mouthguard retention and fabrication time were assessed. The study demonstrated the practicality of custom-made mouthguard fabrication over fixed orthodontic appliances and recommends the procedure as a useful adjunct to orthodontic practice.

Open Access

Multidisciplinary treatment from infancy to adolescence of a patient with a unilateral cleft lip and palate: a 16-year follow-up case report

Published Online: 13 Dec 2021
Page range: 367 - 378

Abstract

Abstract

Cleft lip and palate (CLP) are conditions that require long-term management and review from infancy to adolescence. Surgical procedures become easier when nasoalveolar moulding (NAM) measures are applied during the neonatal period. Orthodontic treatment provided for these patients during the progressive dentition developmental periods can achieve positive aesthetic and functional results. In patients affected by a CLP, the lateral incisor in the cleft region is usually missing and multidisciplinary prosthodontic rehabilitation of the edentulous space is often required. In the present case report, positive results of NAM, coupled with orthodontic and prosthodontic treatment are presented for a CLP patient who began management during the neonatal period. In addition, a minimally invasive aesthetic restoration is presented as a solution for the prosthodontic rehabilitation of a missing lateral incisor.

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